      	<form id='form_step6' method='post' action='<?php echo site_url("user/create_account/save/6")?>' onsubmit="return Send('#form_step6');" >
			<table id="form6_container1_tbl" cellspacing='0' cellpadding='0' width="100%">
			    <tr><td colspan='4'>
			    	<div class='lbackground'></div>
					<div class='header_center'>
						Provide Personal Information for Joint Account Holder:
						<div class='rbackground'></div>
					</div>
			    </td></tr>
			    <tr id='joint_personal_name'><td colspan='2'>
				    <label id='jointTitleLbl' for='jointTitle'>Title:*</label>
				    <select id='jointTitle' name='jointTitle'>
					  <option value='Mr.'>Mr.</option>
					  <option value='Mrs.'>Mrs.</option>
					  <option value='Ms.'>Ms.</option>
				    </select>&nbsp;&nbsp;
				    <label for='jointFirstName' id='jointFirstNameLbl'>First:*</label>
				    &nbsp;&nbsp;
				    <input name='jointFirstName' id="jointFirstName" type='text' size='15'></input>
				    </td><td colspan='2'>
				    <label for='jointMiddleName' id='jointMiddleNameLbl'>Middle:</label>
				    &nbsp;&nbsp;
				    <input name='jointMiddleName' id="jointMiddleName" type='text'  size='2' maxlength="2"></input>
				    &nbsp;&nbsp;
				    <label for='jointLastName' id='jointLastNameLbl'>Last:*</label>
				    &nbsp;
				    <input name='jointLastName' id="jointLastName" type='text'  size='15'></input>
			    </td></tr>
			    
			    <tr><td colspan='4'>
			    
			    <div id='space'></div>
			    
			    <div class='lbackground'></div>
					<div class='header_center'>
						Provide Home Address for Joint Account Holder:
						<div class='rbackground'></div>
				</div>
			    </td></tr>
			    <tr><td colspan='4'>
				  <div class='msg_important'>
					P.O Boxes are not accepted
				  </div>
			    </td></tr>
			    <tr><td>
				    <label id='jointCountryMainLbl' for='jointCountryMain'>Country:*</label>
				 </td><td colspan="3">
				    <select id='jointCountryMain' name='jointCountryMain'>
					  <option value=''>Select One</option>
					  <option value=''>------------</option>
					  <?php foreach($countries as $item){?>
					  <option value='<?php print $item->ID; ?>' rel='<?php print $item->AREA_CODE; ?>'><?php print $item->NAME; ?></option>
					  
					  <?php }?>
				    </select>
					 
				    </td></tr>
				    <tr><td>
						<label for='jointAddressLine1Main' id='jointAddressLine1MainLbl'>Address line 1:*</label>
				    </td><td colspan='3'>
						<input name='jointAddressLine1Main' type='text' size='45' class="longInput"></input>
				    </td></tr>
				    
				    <tr><td >
						<label for='jointAddressLine2Main' id='jointAddressLine2MainLbl'>Address line 2:</label>
				    </td><td colspan='3'>
						<input name='jointAddressLine2Main' type='text'  size='45' class="longInput"></input>
				    </td></tr>
				    
				    <tr><td>
						<label for='jointCityMain' id='jointCityMainLbl'>City/Town:*</label>
				    </td><td>
						<input name='jointCityMain' type='text' size='20'></input>
				    </td><td>
						<label for='jointRegionMain' id='jointRegionMainLbl'>County/State:</label>
				    </td><td>
						<input name='jointRegionMain' id='jointRegionMain' type='text' size='20'></input>
				    </td></tr>

				    <tr><td>
						<label for='jointPCodeMain' id='jointPCodeMainLbl'>Postal Code:</label>
				    </td><td colspan="3">
						<input name='jointPCodeMain' type='text' size='20'></input>
				    </td></tr>

				    <tr><td colspan='4'>
						<label for='jointCurrentYears' id='jointCurrentYearsLbl'>Years of current address:* </label>
						<select id='jointCurrentYears' name='jointCurrentYears'>
						    <option value=''>Select One</option>
						    <option value='1'>0 - 1</option>
						    <option value='2'>1 - 2</option>
						    <option value='3'>2 - 3</option>
						    <option value='4'>3+</option>
						</select>
				    </td><tr>

				    <tr><td colspan='4'>
					  <label for='jointHomePhoneMain1' id='jointHomePhoneMain1Lbl'>Home Phone:* </label>
					  <input id='jointHomePhoneMain1' name='jointHomePhoneMain1' type='text' size='8' maxlength='6'></input>-
					  <input id='jointHomePhoneMain2' name='jointHomePhoneMain2' type='text' size='8' maxlength='6'></input>-
					  <input id='jointHomePhoneMain3' name='jointHomePhoneMain3' type='text' size='12' maxlength='10'></input>
					  <br />
					  <label for='jointMobilePhoneMain1' id='jointMobilePhoneMain1Lbl'>Mobile Phone: </label>
					  <input id='jointMobilePhoneMain1' name='jointMobilePhoneMain1' type='text' size='8' maxlength='6'></input>-
					  <input id='jointMobilePhoneMain2' name='jointMobilePhoneMain2' type='text' size='8' maxlength='6'></input>-
					  <input id='jointMobilePhoneMain3' name='jointMobilePhoneMain3' type='text' size='12' maxlength='10'></input>

					  <div id='phoneHint' class='msg_important'>
						(country code + area code + number)
					  </div>
				    </td></tr>
			</table>
			
			<div id="space"></div>

			<div id='previousAddress'>
			      <table id="form6_container2_tbl" cellspacing='0' cellpadding='0' width="100%">
			      <td colspan="4">
						<label>Enter previous address:</label>
				  </td>
			      <tr><td>
				  	<label id='jointCountryPrevLbl' for='jointCountryPrev'>Country:*</label>
			      </td><td colspan="3">
					  <select id='jointCountryPrev' name='jointCountryPrev'>
					  <option value=''>Select One</option>
					  <option value=''>------------</option>
					  <?php foreach($countries as $item){?>
					  <option value='<?php print $item->ID; ?>' rel='<?php print $item->AREA_CODE; ?>'><?php print $item->NAME; ?></option>
	
					  <?php }?>
					  </select>
			      </td></tr>
			      <tr><td>
				  <label for='jointAddressLine1Prev' id='jointAddressLine1PrevLbl'>Address line 1:*</label>
			      </td><td colspan='3'>
				  <input name='jointAddressLine1Prev' type='text' size='45'  class="longInput"></input>
			      </td></tr>

			      <tr><td >
				  <label for='jointAddressLine2Prev' id='jointAddressLine2PrevLbl'>Address line 2:</label>
			      </td><td colspan='3'>
				  <input name='jointAddressLine2Prev' type='text'  size='45'  class="longInput"></input>
			      </td></tr>

			      <tr><td>
				  <label for='jointCityPrev' id='jointCityPrevLbl'>City/Town:*</label>
			      </td><td>
				  <input name='jointCityPrev' type='text' size='20'></input>
			      </td><td>
				  <label for='jointRegionPrev' id='jointRegionPrevLbl'>County/State:</label>
			      </td><td>
				  <input name='jointRegionPrev' type='text' size='20'></input>
			      </td></tr>

			      <tr><td>
				  <label for='jointPCodePrev' id='jointPCodePrevLbl'>Postal Code:</label>
			      </td><td colspan="3">
				  <input name='jointPCodePrev' type='text' size='20'></input>
			      </td></tr>

			      </table>
			</div>

			<div id='separate_mailing_container'>
			      <input name='jointSeparateMailing' id ='jointSeparateMailing' type='checkbox' value='1'></input>
			      <label for='jointSeparateMailing' id='jointSeparateMailingLbl'>I would like to provide a separate mailing address:</label>
			</div>
			
			<div id="space"></div>

			<div id='mailingAddress'>
			      <table id="form6_container3_tbl" cellspacing='0' cellpadding='0' width="100%">
			      <td colspan="4">
					<label>Enter mailing address:</label>
				  </td>
			      <tr><td>
				  <label id='jointCountryMailingLbl' for='jointCountryMailing'>Country:*</label>
			      </td><td colspan="3">
				  <select id='jointCountryMailing' name='jointCountryMailing'>
				  <option value=''>Select One</option>
				  <option value=''>------------</option>
				  <?php foreach($countries as $item){?>
				  <option value='<?php print $item->ID; ?>' rel='<?php print $item->AREA_CODE; ?>'><?php print $item->NAME; ?></option>

				  <?php }?>
				  </select>

			      </td></tr>
			      <tr><td>
					  <label for='jointAddressLine1Mailing' id='jointAddressLine1MailingLbl'>Address line 1:*</label>
			      </td><td colspan='3'>
					  <input name='jointAddressLine1Mailing' type='text' size='45'  class="longInput"></input>
			      </td></tr>

			      <tr><td >
					  <label for='jointAddressLine2Mailing' id='jointAddressLine2MailingLbl'>Address line 2:</label>
			      </td><td colspan='3'>
					  <input name='jointAddressLine2Mailing' type='text'  size='45'  class="longInput"></input>
			      </td></tr>

			      <tr><td>
					  <label for='jointCityMailing' id='jointCityMailingLbl'>City/Town:*</label>
			      </td><td>
					  <input name='jointCityMailing' type='text' size='20'></input>
			      </td><td>
					  <label for='jointRegionMailing' id='jointRegionMailingLbl'>County/State:</label>
			      </td><td>
					  <input name='jointRegionMailing' type='text' size='20'></input>
			      </td></tr>

			      <tr><td>
					  <label for='jointPCodeMailing' id='jointPCodeMailingLbl'>Postal Code:</label>
			      </td><td colspan="3">
					  <input name='jointPCodeMailing' type='text' size='20'></input>
			      </td></tr>

			      </table>
			</div>
			
			<div id='submit_section' style='text-align:center;'>
			      <input type='submit' value='Save & Continue' title='Save the form and continue to the next step'/>
			</div>
		</form>